Transcription
Insulin resistance is a key risk factor for numerous chronic diseases, most notably type 2 diabetes, but also heart disease, chronic kidney disease, or Alzheimer's disease. However, most people don't even know whether they are insulin resistant, what causes it, and what can be done about it. This is tragic because insulin resistance is almost always preventable and reversible.
In this video, I will summarize what insulin resistance is, share simple tests that you could use to measure whether you are insulin resistant, discuss how to determine why you are insulin resistant, and explain what you can do to prevent or reverse it.
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Welcome to Nerfed by Science on YouTube. My name is Mario, and on this channel, I share evidence-based information about nutrition and the prevention of chronic disease. In this video, we'll address the following questions: What is insulin resistance and why is it important? How can you assess whether you are insulin resistant? How can you assess why you are insulin resistant? And this is particularly important because insulin resistance can have many different causes. Insulin resistance in an 80-year-old frail lady, a 24-year-old male college student, a 44-year-old mom, and a 30-year-old obese truck driver may superficially look the same. They're all insulin resistant. However, the root causes that make each of them insulin resistant could be fundamentally very different, which means that they need to understand why they are insulin resistant and take very different actions to reverse it. We will then discuss how you can reverse your insulin resistance. And for those of you who are not yet insulin resistant or who have managed to reverse the insulin resistance, we will also address how to maintain normal insulin sensitivity. My goal with this video is to empower you to understand insulin resistance for what it is: one of the most important risk factors for chronic disease, and to fully understand what you need to do to maintain or achieve optimal insulin sensitivity. Let's dive into it.
What is insulin resistance? Insulin is a hormone produced by the beta cells in the pancreas that has numerous functions in the body. Most notably, it binds to the insulin receptor on the surface of cells, which causes these cells to move glucose transporters to the cell surface. Glucose from the blood can then enter the cells through these glucose transporters. What this means is that insulin helps move glucose out of your blood and into your cells where it can be used for energy. As a result, blood glucose levels fall. Insulin is a key component of regulating your blood glucose levels after a meal. So, if you want to have normal blood sugar levels, it is important that this process works well. Unfortunately, there are quite a few things that can throw a monkey wrench into this process such that insulin may still bind to the insulin receptor, but for one reason or another, this is less effective at causing glucose transporters to move to the cell surface. We call such a condition insulin resistance. It means that the amount of glucose that can be taken up into the cells per one insulin molecule is reduced. When this happens, one of two things will follow.
The first is that the body senses that the blood glucose level remains higher for longer and will simply produce more insulin to compensate for the insulin resistance. The blood insulin concentration rises, and this larger amount of insulin now gets the job done. Glucose can now readily be taken up into the cells, and blood glucose levels will remain in the normal range. So, in this scenario, blood glucose levels remain normal, but blood insulin concentrations would now be chronically elevated, particularly after eating a meal containing carbohydrates. The insulin concentration in blood can be several fold higher in insulin resistant people than in insulin sensitive people because more insulin is required to bring all the glucose from the meal out of the blood and into cells. Again, that emphasizes that in this scenario, none of this is apparent if we only measure blood glucose levels. This is not apparent from the fasting glucose concentration, not from the glucose levels in an oral glucose tolerance test, and not from an HbA1c lab test. It's also not readily apparent from CGM data. But later in this video, I'll share how you can use your CGM data to detect clues that you may be insulin resistant. We'll also talk about other tests that you could have done to assess whether you are insulin resistant.
First, however, let's discuss the second scenario of what can happen if someone becomes insulin resistant. In that scenario, the pancreatic beta cells are unable to make more insulin. Or, to be more precise, maybe they can make more insulin, but the key point is that the beta cells cannot produce enough insulin to fully compensate for the level of insulin resistance. In that case, less glucose can be taken up into the cells, and as a result, the blood glucose concentration rises measurably more after and stays higher for longer. Glucose intolerance develops, which eventually can lead to pre-diabetes and then type 2 diabetes. In this scenario, insulin levels after a meal and throughout the day are typically slightly or massively elevated. Again, the key point here is that the body is not able to produce enough insulin for the given level of insulin sensitivity.
This second scenario, glucose intolerance, is certainly not ideal because we know that the resulting higher blood glucose levels raise the risk of many chronic diseases. However, the first scenario of insulin resistance is also not great because even if we can keep blood glucose levels in the normal range, having chronically elevated insulin levels by itself is a risk factor for chronic diseases. And maybe most importantly, most of the factors that can cause insulin resistance are also major chronic disease risk factors in their own right. So, you really want to know whether and why you are insulin resistant. Knowing that will give you the knowledge to take targeted action to reverse the condition by addressing its root cause or causes.
How to determine if you are insulin resistant? In clinical research studies, we use some complicated methods to figure out if someone is insulin resistant. The problem is that these tests are usually not offered in clinical care. So, this is not something you could easily have measured. Just in case you're interested and want to Google this to learn more, the gold standard test is called a hyperinsulinemic euglycemic clamp, or clamp for short. A reasonably solid alternative is the so-called Kraft test. Fortunately, the gold standard test correlates pretty highly with two simple tests that are affordable and that you may already get in your routine blood test results, or that you could at least request from your doctor. All that's required for these two tests is a fasting blood sample.
The first one is HOMA-IR. I have previously covered that one in a separate video, so check this out after watching this video if you'd like more detailed information. In short, HOMA-IR is based on fasting glucose and fasting insulin using this formula here. Fasting here means the blood should be drawn in the morning after an overnight fast of at least 12 hours. The formula was created so that normal insulin sensitivity leads to HOMA-IR values of around one. I would suggest that everything up to 1.5 can be seen as perfect insulin sensitivity. I would define HOMA-IR values between 1.5 and 2.5 as mild insulin resistance, between 2.5 and 3.5 as moderate insulin resistance, and more severe forms of insulin resistance as values greater than 3.5.
There is a second test that it may be even easier for you to obtain. For this one, you take your fasting triglyceride concentration in milligrams per deciliter and divide it by your fasting HDL cholesterol concentration, also in milligrams per deciliter. If your lab measures these in millimoles per liter, you first need to convert these values to milligrams per deciliter. Just pay attention to the fact that the conversion factor is different for triglycerides and HDL cholesterol. In insulin sensitive people, this ratio tends to be lower than 1.8. Values between 1.8 and 2.5 suggest mild insulin resistance, 2.5 to 3 suggests moderate insulin resistance, and values greater than 3.0 a more severe insulin resistance.
There's a third method that you may already be using to get a sense of whether you may be insulin resistant. If you are using a CGM, observe a typical glucose response to any of your meals that include at least some carbs. What you want to look like is that the glucose at its peak never reaches 180 mg/dL, and the level is back roughly to your normal baseline 2 hours after you started eating. So, if your baseline in the fasting state or between meals is around 95 mg/dL, you'll want to be back in that area 2 hours after starting a meal. If your glucose level still hovers substantially above that level 2 hours after starting a meal, say at 110 or 120 mg/dL, that would be indicative of insulin resistance. If this was me, I would then ask my doctor to measure fasting insulin and glucose so that I could calculate HOMA-IR.
To conclude this portion, please be aware that these tests can only provide estimates of whether or not you may be insulin resistant. One particular problem with these measures is that some forms of insulin resistance may not be apparent in the fasting state. I'll talk more about that later. So, please don't think that this is a conclusive assessment. If you have any questions about this, please speak to your doctor.
Now, if you find that you are insulin resistant, what should you do about it? And if your test results show that you have very good insulin sensitivity, what should you do to keep it this way in the future? Let's look at four key dietary and lifestyle factors that you need to get right to reverse your insulin resistance, and that will also help you prevent the development of insulin resistance and glucose intolerance in the future. It may well be one of the best things you can do for your long-term health.
Factor number one: Minimize visceral and ectopic fat in our body. There is only one space suitable for fat storage: the subcutaneous fat tissue right under our skin. As far as we know, fat stored in this location does not cause metabolic complications. Some people can store a lot of fat there such that even if they become very obese, they remain metabolically healthy as long as they can store all of the excess body fat in their subcutaneous fat tissue. We also say that those people have a high personal fat threshold, meaning they can store a lot of their fat in their subcutaneous fat depot. Others are less lucky. They have a very limited storage capacity in their subcutaneous fat tissue, meaning they have a low personal fat threshold. When they gain weight beyond their personal fat threshold, their body needs to find other places to store fat and starts to deposit fat in the visceral fat depot surrounding the inner organs and in tissues that are not made for fat storage, such as the muscle, the liver, and the pancreas. We call this fat storage in organs and the muscle ectopic fat, and it's very undesirable from a health perspective. We understand well that when this happens, it has several consequences. For one, these tissues that now are forced to store fat become insulin resistant. A liver with too much fat is what we call a fatty liver, which is usually insulin resistant. Muscle with fat is insulin resistant. And as an aside, a pancreas that is forced to store fat loses some of its ability to secrete insulin. Aside from this, we also know that people with more visceral and ectopic fat often suffer from low-grade chronic inflammation, and that inflammation can make insulin resistance worse. I talk about this in much more detail in my video about the personal fat threshold hypothesis, so feel free to check this out after this video. I've linked all related videos in the description box below.
Relevant to this video is the question of how you can know whether you have excess visceral and ectopic fat. Of course, you could have a DEXA scan done to measure your total body fat mass and obtain an estimate of your visceral fat mass, or you could have an abdominal MRI scan done to measure your visceral and liver fat, but that is not a viable option for most people. Unfortunately, we don't have any one biomarker that we could measure in our blood that would tell us whether we have excess visceral and ectopic fat. However, several measures correlate more or less strongly with visceral and ectopic fat, and by combining these, you can get a good sense of whether you may carry excess visceral and ectopic fat. To help you with this, I have created this poster here, which you can download for free. I've left the link in the description box below. Make sure to use the right poster for your sex and race because some of the cutoffs are different for men versus women and white versus non-white people. Then get measurements of as many of these measures as you can. Waist circumference is a direct measure of how much fat we store in our belly, and because visceral fat directly increases waist circumference, it can be a good surrogate measurement of visceral fat mass. The other measures are all downstream consequences of carrying excess visceral and ectopic fat. So, if you find that all or most of these measures are in the green portions of these bars, then you probably don't have excessive visceral and ectopic fat. If, by contrast, most of these are in the orange and red portions of these bars, you should assume that you have some visceral and ectopic fat. The further on the right these are on average, the more visceral and ectopic fat you probably have. If yours looks like this here, I would certainly encourage you to speak to your doctor about this and also to educate yourself and take action to address this issue.
Okay, what can you do to prevent or reverse excess visceral and ectopic fat? Well, if you currently don't see evidence of excessive visceral and ectopic fat, try not to gain weight. And if you do already have excess visceral and ectopic fat, losing at least some of your excess body weight would be helpful. The good news here is that even losing just, say, 5 or 7% of your body weight can reduce both visceral and ectopic fat by 40, 50% or more.
What do I see as the best way to prevent weight gain or to lose weight and have a chance to keep it off? My approach of choice would not be to count and actively restrict calories, but to focus on maximizing the quality of your diet in very specific ways to make sure you consume fewer calories spontaneously because the foods you eat are more filling or more satiating per calorie. So, what should you do if you want to be comfortably satiated with fewer calories and lose weight? I've just published a video on this topic, and I certainly recommend you check it out after this one here. If you see evidence of excessive visceral and ectopic fat, I don't want to repeat the entire video here. So, let me just summarize the seven key strategies:
1. Stop drinking sugar-sweetened and alcoholic beverages.
2. Replace ultra-processed foods with unprocessed or minimally processed foods.
3. Minimize your consumption of hyper-palatable foods consisting of fat and sugar, fat and salt, or refined grains and salt.
4. Consume mostly meals with a low energy density by using added fats and oils, added sugars and syrups, and refined grains and starches sparingly.
5. Center each meal around a solid portion of a protein-rich food and high-fiber plant foods.
6. Follow time-restricted eating and eat only in a 6 to 10-hour window each day.
7. Identify what may be contributing to any non-hunger eating and find other ways to respond to these triggers.
Now, if you currently do not have excess visceral and ectopic fat, adopting these strategies, or most of them, will most likely be sufficient to prevent weight gain in the future. However, if you find that you need to lose excess visceral and ectopic fat, you will probably need to apply these strategies more rigorously still. If you cannot lose enough weight using this approach, experiment with different implementations of these general strategies. For example, for some people, using these strategies to design a highly satiating low-carb diet can be a great approach. For others, using the principles outlined here to design a plant-based low-fat diet can be something they enjoy long-term and can lose weight with. I'm pretty confident, however, that whichever specific diet you decide on, prioritizing these strategies here will be an important foundation to help you control your calorie intake naturally. If you find that you cannot lose weight using this approach, or not enough, I would also recommend that you talk to your doctor about other weight loss approaches. I believe in a food and lifestyle first kind of approach, but I also see some of the new GLP-1 medications as a blessing for people who cannot get to a healthy body weight otherwise, and taking medications and improving the quality of your diet don't have to be mutually exclusive.
Factor number two: Increase your muscle mass. Just like having too much visceral and ectopic fat causes insulin resistance, we can have the opposite problem when it comes to our muscle mass. Too little muscle mass can also cause insulin resistance, which is often a core problem in lean and elderly people who become insulin resistant. How do you know if you may have too little muscle mass? Well, you could certainly have a DEXA scan done to measure your lean body mass, some of which is muscle mass. However, that would not be my primary suggestion. Instead, I would say that if you do not currently do any form of exercise, and particularly resistance training, you will undoubtedly benefit from these activities. So, I strongly suggest engaging in some form of resistance training at least twice weekly. If you are currently insulin resistant and not engaged in resistance training, you may see very profound improvements in your insulin sensitivity. And really, don't think you need to register at a gym and lift enormous weights immediately. That can be an intimidating thought for many people. Start where you are right now. Even a short routine consisting of body weight exercises such as push-ups, squats, lunges, and crunches can be a great way to start. And if you cannot do a push-up, do it against the wall or countertop. There are also great workout programs available here on YouTube or on apps that can work great to get you going with no or little equipment requirements. And once you are more comfortable with the idea of training to build muscle mass, you can always take it a step further and consider a gym. Whatever you do, however, make sure to do each exercise with good form and give it an honest effort, such that you go close to what your muscles can currently do to give them a reason to grow. Muscles grow when we work and challenge them. I'm linking a few channels in the description box below to help you understand how to establish an effective but safe workout. And of course, if you are not sure you can safely engage in an exercise routine, make sure to talk to your doctor first.
Before we move on, one more suggestion: engaging in resistance training is particularly important if you are trying to lose weight because ideally, you would lose your excess visceral and ectopic fat but hold on to your muscle tissue. Also, remember that earlier in the video, I briefly mentioned the value of increasing protein intake because a high protein diet is more satiating per calorie than one low in protein. A higher protein intake has another benefit: it provides building blocks, amino acids, for your body to make muscle tissue, and this is particularly important when you are trying to build muscle and also when you're losing weight to minimize muscle loss.
The Nourish by Science Prevention Program, by the way, if you like learning how to minimize your risk of chronic disease but feel you could use more help to act upon these strategies, consider joining me in the Nourish by Science Prevention Program. Together with like-minded people, you'll have direct access to me in live video calls where you can ask me questions, and we regularly run challenges on specific topics such as improving insulin sensitivity, optimizing our fasting lipid profile, avoiding blood glucose spikes, or how to eat to meet all micronutrient requirements while minimizing anti-nutrient risks. If you're interested, click the link in the description box below to learn more.
Factor number three: Minimize sedentary time. In addition to engaging in intentional exercise as I just described, I also recommend reducing your sedentary time, or time spent sitting and not moving during waking hours. So, if you spend multiple hours sitting while working, commuting, eating, reading, watching television, crafting, or for whatever reason, consider getting up and moving around for a few minutes at least once per hour. Formal exercise is very important, but even if you formally exercise a few times per week, you may still suffer the negative consequences of too little physical activity if you sit for much of the rest of the day. So, what I suggest here is that you start thinking about yourself in the same way as you would think about, say, a dog or a horse that need to be moved to be healthy. It's not that different with our body. Humans evolved moving for a good part of most days, and if we want to remain healthy and insulin sensitive, we need to move our bodies regularly.
Factor number four: Meet all of your micronutrient and fiber needs regularly. We have good evidence that several micronutrient deficiencies can or may cause insulin resistance, and that meeting the daily requirements can improve insulin sensitivity in people with deficiencies in these micronutrients. Similarly, we have good evidence that increasing fiber intake can improve insulin sensitivity in people with low fiber intake. I'm not going to discuss all of the different micronutrients that affect insulin sensitivity separately here. I don't want to make this about just a few minerals or vitamins because then everyone will simply take these as supplements. There is potentially room for supplementation, but the much bigger point here is to remind you that one key objective of a healthy diet is to regularly provide our bodies with all the essential vitamins, minerals, and trace elements.
So, here is what I suggest: Make sure to eat a diet rich in a variety of nutrient-dense foods, mostly in the unprocessed or minimally processed form. Ideally, these include plant foods such as vegetables of all kinds, fruit and berries, legumes such as beans and lentils, mushrooms, whole grains, nuts, and seeds, and also animal foods such as unprocessed meats, fish and shellfish, eggs, and dairy products. It is similarly vital to know which foods to avoid or minimize as much as possible. These here are all what we call empty calorie foods. They do not provide fiber, and they also all have a very low concentration of micronutrients. To maximize the nutrient density of your diet, minimize refined grains, added sugars and syrups, added fats and oils, and all foods made from these, such as white bread, pancakes, cakes, pretzels, cookies, donuts, or candy bars. This category also includes many ultra-processed foods such as soda, chips, crackers, sweetened breakfast cereals, and the like. All of these have a lot of calories but provide almost nothing else of any nutritional value to you.
You can use this general information to create your own way of eating that you enjoy. If you want to make this more plant-heavy and lower in fat, just prioritize veggies, fruit and berries, legumes, or mushrooms, and whole grains with just an occasional piece of meat. If you want to eat meat, fish, or seafood, yogurt, or cheese, or an egg every once in a while, or vice versa. If you prefer low-carb, focus more heavily on meat, fish and shellfish, eggs, dairy foods, nuts and seeds, olives, and avocados, and add as many non-starchy vegetables and leafy greens as you like. My suggestion is always to include plenty of plant foods, even if your diet is low-carb and largely animal-based, and always to include some animal foods, even if your diet is heavily plant-based or low-fat. That is because some of the essential micronutrients lacking in plant foods can be found in a high concentration in animal foods, and vice versa.
For those of you who are not sure that you meet all micronutrient requirements regularly and would like to take it a step further, here is another suggestion: For at least 3 days, better more, keep track of everything you eat and enter it into a nutrition analysis software. I find Cronometer to be a very good choice for this because it provides detailed micronutrient information. Keep track of everything you eat and drink with as much detail as possible. Try to be precise with the amounts of everything you eat. While you do this, try to eat the same way you always eat. This is an assessment, so try not to make any changes yet. Include weekday and at least one weekend day if your diet differs on weekends. Then examine whether you regularly meet the recommended intakes for fiber and all micronutrients. The point here is not that you need to meet requirements for each mineral, trace element, and vitamin every day, but across several days, you should be at 100% or at least close for all. For fiber, I would try to comfortably hit 100% of the recommended amount daily.
If you find that you are commonly low in fiber or any of the essential micronutrients, consider including specific foods in your diet to address that deficiency. This is a case where Googling can be very helpful. Just type in "foods rich in magnesium," "foods rich in fiber," or "foods rich in vitamin B1," and let yourself be inspired. Alternatively, there's also nothing wrong with considering a supplement, as long as you also make an effort to prioritize a generally nutrient-dense diet rich in unprocessed or minimally processed foods. Why do I suggest that we benefit from prioritizing getting our nutrients from foods and not supplements? Well, look at all of these nutrient-dense foods here. These are not just nutrient-dense, but they are also the very foods we should be eating to make our diet more satiating per calorie, and vice versa. Those foods that are mostly empty calories also happen to be those that tend to make us overeat calories and gain weight. So, you can kill two birds with one stone. If you eat a variety of mostly unprocessed or minimally processed plant and animal foods, you increase your micronutrient and fiber intake, and you make your diet much more satiating per calorie, which will automatically lower your spontaneous calorie intake and help you achieve or maintain a healthy body weight. If you want to reverse insulin resistance, it is impossible to overstate the importance of eating a variety of these nutrient-dense foods, ideally mostly in their unprocessed or minimally processed form, while minimizing liquid calories such as sugar-sweetened and alcoholic beverages, ultra-processed foods, and all of these empty calorie foods here.
If you find yourself overwhelmed with this exercise, consider consulting with a registered dietitian who can help you do this assessment to determine whether your diet is chronically deficient in fiber or any essential micronutrient. This is a good idea, particularly if you don't eat any animal foods, or maybe if you eat no plant foods, or any other extreme diet that relies mostly on a few food groups while excluding others. If you have a medical condition that is associated with malabsorption, such as celiac disease, inflammatory bowel disease, or if you had bariatric surgery, speak to your doctor about potential micronutrient deficiencies. Similarly, if you have a medical condition in which a high-fiber diet would cause problems, such as irritable bowel disease, also speak to your doctor.
There's one micronutrient worth mentioning separately: vitamin D. Vitamin D is actually a hormone that our body can produce from cholesterol in the skin whenever we are exposed to UV light. Depending on where you live, your skin color, and how much time you spend in the sun, how many clothes you wear when you're in the sun, and other factors, you may not be able to produce enough vitamin D yourself. Though, I suggest you ask your doctor to measure your plasma level of 25-hydroxyvitamin D and make sure it's above 20 ng/mL or 50 nmol/L at all times. In my opinion, ideally, you'd aim for the higher end of the normal range, somewhere between 30 and 50 ng/mL, that would be between 75 and 125 nmol/L.
Other potential causes of insulin resistance. In my interpretation of the literature, if everyone got these four key points right, this would reduce the burden of insulin resistance and type 2 diabetes very substantially: eating in a way that minimizes weight gain and specifically visceral and ectopic fat, engaging in resistance training, generally reducing sedentary times, and eating a high-fiber, micronutrient-dense diet. These address the most common and also most actionable root causes of insulin resistance and type 2 diabetes. However, even if you get all of these right, there are a few issues that could still make you insulin resistant. These are less common and also less actionable, meaning in some cases, they are more challenging to address by your diet or lifestyle, and I will only mention them here briefly. These factors are circadian disruption, sleep issues, chronic stress, certain medications, and certain medical conditions.
Let's start with these last two: certain medications and medical conditions. This is a big topic because there are a lot of medications and diseases that can cause insulin resistance, some of them in a very significant way. Among medications, chronic corticosteroid use and also statins are such examples. And among medical conditions, sleep apnea and thyroid dysfunction come to mind. My recommendation here is that if you are insulin resistant or have pre-diabetes or type 2 diabetes, and you regularly take a medication, or if you have a chronic medical condition, talk to your doctor about the connection to insulin resistance. There are cases where you can switch to a different medication or lower the dose of a medication, and that could certainly help you improve your insulin sensitivity. Similarly, work with your doctor to treat any medical condition that may make you insulin resistant. Two prominent examples here are sleep apnea and thyroid disease. In both cases, getting these diagnosed and treated can have a very profound impact on insulin sensitivity.
Let's also talk briefly about circadian disruption. Circadian disruption means that your inner circadian clock is out of sync with the natural light-dark rhythm we experience. We experience this for a few days when we are jet-lagged and more chronically in people who do shift work, but this can actually occur to some degree in everyone. A common manifestation of circadian disruption is that it causes insomnia or other sleep issues. The best thing you can do to maintain a normal circadian rhythm is to first expose yourself to bright natural lights during the day, particularly early in the day. Second, to limit bright and particularly blue light in the later part of the evening and at night. And third, to consume mostly food during the daylight and early evening hours. The latter is called early time-restricted eating, where most typically, food intake is restricted to an eating window of 6 to 10 hours, with no food intake after about 6:00 or 7:00 p.m. Aside from circadian disruption, sleep deprivation could be caused by many other factors, not all of which are under our control. If you have trouble getting at least 7 hours of good quality sleep every night, I suggest you discuss this with your doctor.
And lastly, chronic stress can be a major contributor to insulin resistance. Now, this is a tricky one because, just like sleep deprivation, no one chooses to be chronically stressed, and in many cases, we cannot immediately change whatever causes us to be stressed. If you are stressed at work, it's not a simple act to switch jobs or reduce hours at work. And if you have stress with a family member, that may also not be just under your control to resolve that immediately. So, I'm aware that this can be a big challenge. I'm listing this here because if you are chronically stressed, it is important to understand that this alone could contribute to insulin resistance and glucose intolerance. Try to address whatever causes you to be stressed and consider adopting stress management techniques such as meditation, yoga, walks in nature or park, and regular exercise.
Summary and conclusions: Insulin resistance is a significant risk factor for several chronic diseases, and in my opinion, everyone should regularly have a test to assess whether they are insulin resistant. Fasting insulin and HOMA-IR should ideally be part of the routine lab test panel because insulin resistance clearly is as much a risk factor for chronic diseases as all of the other biomarkers we measure routinely, such as fasting lipids, fasting glucose, or blood pressure. As this is not the case yet, you may need to pay for the test yourself, but whatever you need to do, get it done every few years. Then, make sure to get the four big diet and lifestyle factors right, and to do this, I recommend all of the following:
1. Stop drinking sugar-sweetened and alcoholic beverages.
2. Replace ultra-processed foods with unprocessed or minimally processed foods as much as possible.
3. Minimize your consumption of hyper-palatable foods consisting of fat and sugar, fat and salt, or refined grains and salt.
4. Consume mostly meals with a low energy density by using added fats and oils, added sugars and syrups, and refined grains and starches sparingly.
5. Center each meal around a solid portion of a protein-rich food and high-fiber plant foods.
6. Follow time-restricted eating and eat only in a 6 to 10-hour window each day.
7. Identify what may be contributing to any non-hunger eating and find other ways to respond to these triggers.
Following these seven rules will make your meals much more satiating per calorie and minimize your exposure to the highly tempting foods we tend to overeat. Together, this will lower the number of calories you spontaneously need to consume to feel full, reducing your risk of weight gain and possibly even leading to weight loss. At the same time, your diet will have a very high content of fiber and essential micronutrients. And again, these rules can be implemented very flexibly as a low-fat, mostly plant-based diet, as a low-carb, mostly animal food-based diet, or anything in between.
Then,
8. Engage in muscle-building exercises, ideally resistance training, at least two to three times per week.
9. Minimize long uninterrupted periods of sitting. Make it a habit to move more, go on short or long walks throughout the day, or just stretch a bit while you're watching TV, or do 5 minutes of body weight exercises, a few squats and a few push-ups, as a break from working at a desk.
If you get these dietary and lifestyle factors right in a way that you can maintain happily forever, you will dramatically reduce your risk of becoming insulin resistant and glucose intolerant. In my experience running clinical trials in people with metabolic disease, I'd say that if everyone ate food that is supportive of our biology rather than nutrient-poor and energy-dense junk that makes us overeat chronically, and if everyone made it a habit to move a lot and engaged in at least some resistance training, most of the epidemic of insulin resistance and type 2 diabetes would just disappear. Considering that currently more than 1 billion people worldwide have diabetes or pre-diabetes, and many more are suffering from insulin resistance, isn't that mind-blowing? Now, that's not to say that these are the only causes of insulin resistance and type 2 diabetes. As we discussed, if you suffer from any of the other potential causes of insulin resistance, such as sleep deprivation, chronic stress, or a medical condition, speak to your doctor and try your best to address the issue.
Okay, that's it for this video. I have left a lot of links to other videos and resources in the description box below. As always, I have again published a blog post that provides all of the links and scientific references. If you value this video, please consider leaving a like and share the video with any family members, friends, or random folks on the street who you think may be interested in this topic. Lastly, I'd like to thank the patrons of the channel who generously support the generation of this free content through a regular contribution. I make these videos without accepting any sponsorship deals, I don't do any affiliate marketing, and I do not in any way affiliate myself with the food, supplement, or pharmaceutical industry. If you value unbiased, evidence-based content and would like to also support the channel, please find the link to the Nerfed by Science Patreon page in the description box below. Thank you and take care.
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